Provider First Line Business Practice Location Address:
415 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARRINGTON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58421-1671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-652-2521
Provider Business Practice Location Address Fax Number:
701-652-2326
Provider Enumeration Date:
07/12/2006